Healthcare Provider Details

I. General information

NPI: 1043787757
Provider Name (Legal Business Name): ASHOK L GOWDA, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 BLAND ST
SPRINGFIELD VA
22150-2612
US

IV. Provider business mailing address

PO BOX 419
ODENTON MD
21113-0419
US

V. Phone/Fax

Practice location:
  • Phone: 301-215-7776
  • Fax:
Mailing address:
  • Phone: 301-215-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. IMANI M JOHNSON
Title or Position: BILLING COORDINATOR
Credential:
Phone: 301-215-7776